Biopsychosocial Understanding of Lower Back Pain: Content Analysis of Online
Black, R. Mani*, J. Sullivan
for Health, Activity and Rehabilitation Research, School of Physiotherapy,
University of Otago, Dunedin
Introduction: Lower back pain (LBP) is a leading global burden, causing the most
global disability of any condition. Education is a critical aspect to LBP
management, therefore, it seems reasonable to suggest that increased access to
health information could aid in the management of such a burden. An
understanding of current online LBP information and how its content compares to
a current understanding of LBP is critical if the internet is to become an
effective educational resource in LBP management.
Aims: To analyse publicly accessed online lower back pain information
from a Google search for (1) the degree that psychosocial contributors are
described alongside the traditional biomedical approach to explaining LBP; (2)
whether websites use information on pain biology to educate on LBP; (3) any
inaccurate or false information regarding the mechanisms of LBP.
Methods: An online search was conducted using the Google search engines of
six major English speaking countries. Website content was analysed using three
checklists developed for the purpose of this study - Biopsychosocial
information categorisation checklist and scoring criteria; pain biology
information checklist; and the inaccurate information checklist.
Results: Of the fifteen websites analysed, the content of 26.7% of websites
was classified as ‘biomedical’, 60% ‘limited psychosocial’ and 13.3%
‘reasonable psychosocial’; 20% included information on pain biology; 46.7%
inaccurately implied pain to be equal to tissue damage and 46.7% implied
pathways specific to pain transmission.
Conclusions: Online LBP information retrieved through a Google search has
limited to no integration of psychosocial or pain biology information. The
focus on tissue pathology is further supported by the inaccurate descriptions
of pain as equal to tissue damage and as an input to the central nervous
system. Online LBP information needs to be guided by benchmark criteria more
sensitive to the psychosocial contributors to pain.
Acknowledgements: The authors would like to thank Dr Hopin Lee of Neuroscience
Research Australia, Sydney, NSW, Australia for his expert advice in developing
the analysis tools for the study.
1. Hendrick PA, Ahmed OH, Bankier SS, et al. Acute
low back pain information online: an evaluation of quality, content accuracy
and readability of related websites. Man
2. Lee H,
McAuley JH, Hübscher M, et al. Does changing pain-related knowledge reduce pain
and improve function through changes in catastrophizing? Pain